Real Suicide Prevention or Self-Satisfied Nonsense?

It's Suicide Prevention Month/Week/Whatever again. Those of us who are or have been suicidal know suicide prevention as a year-round, full time job. Those of us who are or have been suicidal have a whole lot of experience at preventing suicide. Is anyone interested to hear from us? Some of the following came from an earlier post. It bears repeating, 'cuz evidently even some bright people have some strange ideas. Like:

Suicide is not a choice

The way people talk, you'd think we sit down and make a list, pros and cons of suicide. Then based on our calculations, we make some kind of decision. She chose to end her life. Or, How could he have been so selfish.

This is called the volitional theory of suicide, suicide as an act of will. The suicide prevention approach that addresses it is to weigh in on that list of pros and cons, like Jennifer Michael Hecht's book, Stay.

You know -- Suicide is a permanent solution to a temporary problem. Or, Think of what you'll miss out on. Or, whatever. In other words, how dumb or short-sighted or irresponsible or selfish you must be to decide to kill yourself.

One More Reason to Ask About Suicide

It's always dangerous to listen in when psychiatrists and therapists talk among themselves. I used to do a whole series, OMGThat'sWhatTheySaid, devoted to overhearing what they say about us. More than one post was devoted to their discourse about suicide.

There's been lots of opportunity to overhear in the last several days since the Meghan Markle interview. The clinicians weighed in on Stacey Freedenthal's New York Times article where she dared to repeat what some doctors and therapists have told her (an expert in the field of suicide and suicide prevention), that they fail to ask the question about suicide. There have been proclamations about professionalism, training, protocols, risk-assessment, and - God help us - malpractice.

I started to write a post reporting my own experience of risk-assessment and the failure of my doctor and therapist to ask, even as they told me they were concerned about me. Concerned about what exactly?

But I began to feel -- empty. Like the whole conversation, including my part in it, was missing the boat.

The boat is pain.

What is at stake is whether we have a safe place to talk about our most painful feelings.

Confessions of the Good Suicide Survivor Story

I was suicidal. I nearly killed myself. I am glad I didn't do it. Because I got better.

Moral of the story: You will, too.

That's it. That's the good survivor story. Hopeful. Virtuous. I have told that story, and when I do, I get all kinds of strokes, including publication of my writing on other websites.

Some of it is true. It did get better. For me. For now.

For now.

There is more to the story. When I tell the more, I do not get publication. I don't even get acknowledgement that my submitted piece was received. I guess I am submitting to the wrong websites, to places that have one story they want to tell, the good survivor story.

And like I said, it's true, some of it. According to David Conroy, there are 50 million people alive today who have struggled, are struggling, or will struggle with suicide. 45 million of them will die of... something else. That's success, right? 90% of us will find another way.

But that's not the same as the good survivor story. Because for the 45,000,000 of us who survive, we have all kinds of stories.

Suicide is Not a Mystery - Get Beyond the Romance to Get to the Work

Suicidal people have not been quiet this year during Suicide Prevention Month. Most years we are the topic of conversation, not the source of the content of all these campaigns. But Twitter, at least, has been filled with our own voices this year. I have always shot my mouth off, and seldom taken the party line. Which means my voice is never included in the campaigns of the typical mental health organizations.

The following is an example, a post from a previous Suicide Prevention Month, edited with my more current thoughts on the matter.

This is Suicide Prevention Week - from September 8, 2011

When I started Prozac Monologues, I didn't know there was a Suicide Prevention Week. I spent a month writing about suicide in June, 2009. I chose June because it is the month when the highest number of suicides take place. So I wonder why the officially designated week is in September. Maybe because when everybody else is so happy about the sunshine in June, they wouldn't give any thought to the darkness? Maybe because they didn't ask those who are suicidal?

If you want to know my take on suicide prevention, here is the link for those original posts. Among the Labels in the right-side column, you will find links to other posts tagged suicide, suicide prevention, and the like.

Looking back at these posts, I wish I had less to say about suicide. But having this much to say, and frankly, a lot more, I think it's best I go ahead and say it. That was my POV for The Suicide Monologue. And I'm sticking to it. I urge you to take the same approach. If you have something to say about suicide, go ahead and say it.

You know, all those years we never talked out loud about cancer, our silence never saved a single life.

Diagnosing Bipolar - Doing Better to Prevent Suicide

How can I be a better psychiatrist for you?

Frankly, I was gobsmacked by that question. It came in response to reading my book, Prozac Monologues: A View from the Edge. The book is a comedic memoir of misdiagnosis and a self-help book for bipolar. It is both uproariously funny and brutally frank about my suicidal episodes, usually at the same time.

There are two directions to go with that question. This particular psychiatrist cares about both.

What kind of behaviors and qualities could he display that would make the relationship more helpful? Honestly, not all psychiatrists are interested in this question. I don't do relationships; I use psychopharmacology to treat psychiatric disorders, a psychiatrist once told me. Well, that had the benefit of clarifying things.

How can I improve my diagnostic skills? Nevertheless just about any psychiatrist wants to get the answer to the puzzle right, even the ones who treat patients as no more than a puzzle.

Is It Time to Call a Therapist?

There is a difference between feeling depressed and having depression, which makes it hard to figure out what we need right now when - doesn't everybody feel like crap?

What you are feeling right now might be the entirely normal reaction to this currently abnormal world. Here is what's happening: everybody is experiencing trauma at the same time. Exhaustion, trouble concentrating, insomnia, hopelessness, these are common physical, emotional, and cognitive reactions to trauma. They are also symptoms of a depressive episode. And depression, the illness of depression can lead to serious complications, substance abuse, relationship problems, suicide. Not to mention that it simply sucks the joy out of living. Depression, the illness needs to be treated.

So do you need to see a doctor? It depends. A recent New York Times article can help you sort it out.

Misconceptions about Suicidal Thoughts

My publicist seems to think people have a lot of misconceptions about mental illness (she's right), because many of her questions go there. You are very open about discussing your own struggles with suicidal thoughts. What do you think are the biggest misconceptions about people going through similar experiences? So today's post will focus on suicidal thoughts or suicidality.

Suicide is not a choice

The way people talk, you'd think we sit down and make a list, pros and cons of suicide. Then based on our calculations, we make some kind of decision. She chose to end her life. Or, How could he have been so selfish.

This is called the volitional theory of suicide, suicide as an act of will. The suicide prevention approach that addresses it is to weigh in on that list of pros and cons, like Jennifer Michael Hecht's book, Stay.

You know -- Suicide is a permanent solution to a temporary problem. Or, Think of what you'll miss out on. Or, whatever. In other words, how dumb or short-sighted or irresponsible or selfish you must be to decide to kill yourself.

The End of Miracles - A Review

What is it like to have depression with psychotic features?

What is a day like inside a psych ward?

What is the psychiatrist thinking?

Sometimes the best way to explore questions like these is in a story. So here is Prozac Monologues' first review of a novel.

Monica Starkman is a psychiatrist at the University of Michigan whose expertise includes psychosomatic disorders, stress, and women's issues around fertility, miscarriage, and obstetrics. In her debut novel, The End of Miracles, she turns her clinical experience to the story of one woman, Margo Kerber, a long-infertile woman who finally conceives, tragically miscarries, and then... unravels.

Prozac Monologues - A Book is Coming

The life of an author - this author anyway:

Mornings I work on finding my peeps. Twitter has been a revelation to me. I resisted it for years until I discovered what was possible. It's not all politicians and celebrities! I thought I was supposed to do Twitter because that's what you do when you want to sell books. That made me feel icky.

But then somebody reframed it for me:

There are people out there who have a question, a need, a pain point. Can I address their pain point? If so, how do they find me?

Preventing Suicide Among Gun Owners

Can we reconcile a most basic suicide prevention strategy, means restriction with the 2nd Amendment? Gun owners and public health people have to find a way to talk about this. In Oregon, the conversation has begun.

Gun owners in rural have a sense of responsibility and honor. It's a thing. Part of that responsibility is to protect one's family, one's livestock, and oneself. So let us begin by acknowledging that some gun owners, the ones who live in rural areas where suicide rates are growing the fastest, need guns for protection. But they have to do the protecting themselves. The government, on account of distance and distrust, cannot do the job. And then let us acknowledge that one of the things they need to protect their families (and maybe themselves) from is suicide.

Compare states to states.  Compare regions to regions.  Compare states within regions to other states within the same region.  Compare people of the same age group, in any age group, men to men and women to women.  Compare unemployed people to unemployed people, working folk to working folk.  Compare city dwellers to city dwellers, country folk to country folk.

Compare people with depression to other people with depression; people who are suicidal to other people who are suicidal; people who have a plan to other people who have a plan; people who have a past suicidal attempt to other people who have a past suicidal attempt, for God's sake!

More Guns = More Suicides.

Get it? Rural areas have more suicides largely because they have more guns.

Warning Signs and Suicide Hot Lines Won't Fix This

A psychiatrist remembered his first days on his ER rotation. He dealt with a woman who had tried to kill herself. She was homeless, had been taking meth so she wouldn't sleep ever since she had been raped on the street. The supervisor asked what the young doc intended to do. "Prescribe antidepressants?"

They both knew how stupid that sounded.

In the 80s and 90s, they thought they had this suicide thing figured out. As the number of prescriptions for Prozac rose, the suicide rate was falling. It was widely claimed by people who flunked logic that this was epidemiological evidence that Prozac prevented suicide. Just get more people into treatment. This kind of error is common enough to have its own name: post hoc ergo propter hoc. Or maybe there was some economic incentive behind that sloppy thinking...

God and Suicide

Eight years ago I wrote "I don't believe in God anymore." It was the title of a book chapter, a book reflecting on suicide from a Christian perspective, though probably not the Christian perspective that you think about when I say that. More like what goes through the mind of a Christian who is suicidal and is bringing what is left of her theology to the experience and desperately trying to tell the truth about it. The truth. Not what we want the truth to be. Just the truth. It wasn't exactly a suicide note, though it might have been taken that way if that's the way it turned out.

It didn't turn out that way. I recovered. "I don't believe in God anymore" anticipated that I would recover, but that wouldn't make the problem go away. Relapse was statistically probable. I might be in that darkest of places again. This chapter dealt with the problem of suffering. Oh, how tidily that phrase expresses the chaos of a believer's brain when looking into the abyss. But I wouldn't let the tidy answers stand, and I still won't. While I am not so bitter anymore about this remitting, recurring condition of mine, as far as God goes, well, I just don't know as much about God as I used to.

Here is a piece of that chapter:

Although my own soul is a dry desert, I have deep wells from which to draw. While I do not believe in God, so I cannot say the creed, I cannot set my heart on the One who has broken it, I still believe in the communion of saints. As a Christian, I have a big family, across space and time. For now, I ask the rest of my family to do my believing for me.

The lament psalms persist in worship, and worship is how I persist. I listen to Gospel music. I sing along with those whose music it is. I do not have their faith. But I cannot dispute their testimony, what God has done for them, and the power they find in God to get through. I believe in them. I believe in the Brooklyn Tabernacle Choir.

Those whose ancestors survived the Middle Passage, survived slavery, survived Jim Crow, survived the Klan, who still survive today, I don't know how they survive. But they assure me, and I listen to them tell me over and over:

             Everything He said in His word,
               He will do it for you.
               Every prophecy he gave, every promise He made,
               He will do it for you.

Eight years later, I am in remission, not depressed, not even a shadow for the last six months. An eternity! I have challenges. I manage my condition every single day. And my life is good. I work toward a publication date of September 2020. There will be something that comes out of that old hellhole, a book, a different book that offers help and hope to others who have been misdiagnosed and inappropriately treated as I was. And I am very proud of it, Prozac Monologues, the book.

I am not saying it was worth the price. I am not saying that my God issues have been resolved, that some promise was kept, and it's all okay because there was a happy ending. You can say that if you want. But it's a slippery slope, hanging your faith on the happy ending.

David Conroy wrote, Suicide is not chosen. It happens when pain exceeds resources for coping with pain. There is some truth for you. I have been blessed by enormous resources, and they have kept me alive through enormous pain. One of those resources is an unshakable experience of the communion of saints, those who have been there for me across the centuries, from Jeremiah to John of the Cross to the friend who said my prayers for me when I confessed I couldn't pray anymore to the Brooklyn Tabernacle Choir.

I went to church on Sunday with a CD by The Brooklyn Tabernacle Choir. It reminded me of that chapter. And I thought it was time to say thanks. They carried me through.

photo of candle by anonymous, used under Creative Commons license

World Suicide Prevention Day - Keeping It Simple This Year

Two things I wish everybody knew:

No matter how you package it, shaming suicide does not prevent it, and

Understanding never pushed anybody over the edge.

photo of candles by Nevit Dilmen, used under the GNU license.

On Surviving - I Wish Robin Williams Had

Nearly a week's worth of reporting on Robin Williams' death, some of it heartfelt, some of it educational, some of it ignorant bloviating -- even if you have been living under a rock and not heard any coverage at all, you can name the bloviators, can't you.  By now, my readers surely wonder, What is the Prozac Monologues take on his untimely death?

I have written reams on suicide and suicide prevention.  Click on those two links and take your pick.  But skip the Suicide Monologue, at least for another week.  It is inappropriate for another week.  And if you do go there, then mind the humor alert.  I am serious -- about the humor alert, that is.  Some of you won't find it funny. It wasn't written for you.

But before we abandon the suicide conversation in favor of the next thing, let's expand the frame.  Here's the deal.  Of all the people alive on the planet today, 50,000,000 will, at some point in their lifetimes, struggle with suicide.

I can't say we will think about suicide.  Those of you who think about it in passing seem to think that the seriously suicidal think.  There is lots going on inside our burning brains.  But thinking doesn't really describe it.

Antidepressants and Suicide: Defending Prozac

It amazes me how many research scientists seem to have flunked statistics.  Or ought to have.  Me, I majored in the liberal arts.  But at Reed, even those who took Science for Poets would be required to rewrite some of the scientific papers I have read on the subject of antidepressants.

So the vocabulary terms for the week are observer bias and confounding variables.  No worries -- lots of pictures.

Clinical Experience in Defense of Prozac

Let's say you are a doctor treating 100 patients with severe depression.  You give them all antidepressants.  It seems irresponsible not to, doesn't it.  Thirty of them get better.  Fifteen do not make a follow-up appointment.  You switch the fifty-five who are still trying to another antidepressant.  Another fifteen get better.  And another fifteen do not make a follow-up appointment.

Over the course of a year, you get up to fifty whose depression is remission and ten who are still struggling.  You don't know what happened with the forty who are no longer seeing you. They couldn't afford treatment; they didn't like your face; they couldn't find parking; they got worse on your medication. You have no idea.  But you have fifty patients who think you saved their lives.  You feel pretty good about yourself, don't you.

Antidepressants and Suicide: A History

Do antidepressants prevent suicide, or do they cause it?

Yes.

Well, maybe.

It's a no-brainer, right?  People who commit suicide are depressed.  Take away the depression, and how better than with an anti-depressant, and you decrease the risk of suicide.

So what's with the question?  Here is the story:

History of Antidepressants

Suicide Is Not a Choice

I peered over this very overpass on the Eisenhower Expressway. Years ago, there was no the fence along the top, just a rail. It was pie that brought me there. Yes, pie. It was Thanksgiving night, and the holiday was ending without pie.

Of course, it wasn't a reason to commit suicide. Of course, suicide is a permanent solution to a temporary problem. Don't treat me like an idiot with your clever lines.

No, pie brought me there, but that was not why I would jump. Pie was a match, a tiny little three letter match. My problem was a brain filled with gasoline. And one tiny match, that I should have been able to snuff with my fingers, threatened to ignite it and send me over the edge. The shame of being powerless over one tiny match poured on more gasoline.

Suicide Immoral? WTF?

Guilty pleasure: Eavesdropping on psychiatrists talking with each other about us loonies. Like many guilty pleasures, it is not always good for my well-being. But I am endlessly curious. And it has yielded a number of blogposts in the OMGThat'sWhatTheySaid thread.

My go-to source for blog material is Psychiatric Times. It reports the latest news and research in Loony Land. It reflects on the practice of psychiatry. Sometimes it turns to mud wrestling. Oh, the good ol' DSM days!

A couple months ago, one of the editors, Ron Pies wrote a brave (foolhardy?) editorial inspired by Jennifer Michael Hecht's book, Stay: A History of Suicide and the Philosophies Against It. Intending to provoke, he titled it, Is Suicide Immoral?  Let the rumble begin.

Michael Hill and Antoinette Tuff: Lesson in Crisis Intervention

On August 20, 2013, at the Ronald E. McNair Discovery Learning Center in Decatur, Georgia
                       -- nobody died.

Tuesday, the first school shooting of the new school year

                       -- didn't happen.

It started the way these things start.  A disturbed young man went off his meds.  He decided he would die that day.  He did what others have done who wanted to die.

Suicide By Cop

The Suicide Monologue

Suicide Humor

They asked for a trigger alert. This is a humor alert. Oh, well.

I realize some people do not find suicide humor humorous. I get that. I respect this opinion and honor the feelings and experiences behind it.

If you have not read Prozac Monologues before, you need to know that it has always aspired to a bent sort of humor. And in honor of the World Health Organization's World Suicide Prevention Day, today's post, a long time coming, is The Suicide Monologue. Watch me while I attempt humor. You don't have to read it. Just know, it is what it is.